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Forms

HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.

ES = Spanish version available.

Title
Form 3250, Hospital Statute and Rule Waiver Request Application for Facility Physical Plant and Construction Requirements
Form 8670, Daily Physical Activity Log
Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change ES
Form H1010, Texas Works Application for Assistance – Your Texas Benefits ES
Form LSC, Lone Star Card
Form 8587, Nursing Process Toolkit
Form 4116-MHM-AA, Minor Home Modification and Adaptive Aids Summary Sheet
Form LSCS, Lone Star Card Sleeve
Form 3240, Limited Services Rural Hospital (LSRH) License Application
Form 1243-TSI, Verification of Civil Services Benefits - TSI
Form 8669, Daily Food Log
Form 1243, Verification of Civil Services Benefits
Form H0010, Application for Advisory Committee Membership
Form H1901, TIERS Data Collection Worksheet
Form 1026-TSI, Verification of Railroad Retirement Benefits - TSI
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